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Green dentistry: the art and science of sustainable practice

BDJ volume 222, pages 954961 (23 June 2017) | Download Citation

Abstract

Dentistry is highly energy and resource intensive with significant environmental impact. Factors inherent in the profession such as enormous electricity demands of electronic dental equipment, voluminous water requirements, environmental effects of biomaterials (before, during and after clinical use), the use of radiation and the generation of hazardous waste involving mercury, lead etc have contributed towards this. With rising temperatures across the world due to global warming, efforts are being made worldwide to mitigate the effects of environmental damage by resorting to sustainability concepts and green solutions in a myriad of ways. In such a scenario, a professional obligation and social responsibility of dentists makes it imperative to transform the practice of dentistry from a hazardous to a sustainable one, by adopting environmental-friendly measures or 'green dentistry'. The NHS in the UK has been proactive in implementing sustainability in healthcare by setting targets, developing guidance papers, initiating steering groups to develop measures and implementing actions through its Sustainable Development Unit (SDU). Such sustainable frameworks, specific to dentistry, are not yet available and even the scientific literature is devoid of studies in this field although anecdotal narratives abound. Hence this paper attempts to present a comprehensive evaluation of the existing healthcare sustainability principles, for their parallel application in the field of dentistry and lays out a blueprint for integrating the two main underlying principles of sustainability – resource use efficiency and eliminating or minimising pollution – in the day-to-day practice. The article also highlights the importance of social values, community care, engaging stakeholders, economic benefits, developing policy and providing leadership in converting the concept of green dentistry into a practised reality.

Key points

  • Provides a comprehensive overview on 'green dentistry', by way of describing how the practice of dentistry has an impact on the environment and systematically outlining the practice measures that can be implemented at every step, to mitigate these effects.

  • Highlights the current status of sustainable dentistry in theory and practice, with particular emphasis on the steps taken by the NHS and UK government, thus far.

  • Identifies issues and the gaps which need to be addressed in the relatively new area of sustainable dental practice, in order to stimulate the initiation of concrete action by the dental fraternity, leaderships and organisations in this direction.

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References

  1. 1.

    Intergovernmental Panel On Climate Change. CLIMATE CHANGE 2013 The Physical Science Basis. Available at (accessed January 2017).

  2. 2.

    Department for Food, Environment and Rural Affairs. CCRA – UK Climate Change Risk Assessment 2012 – GA0204. Available at (accessed January 2017).

  3. 3.

    UK Climate projections. Website. Available at (accessed January 2017).

  4. 4.

    Business Dictionary. Green definition. Available at . (Accessed 9th January, 2017).

  5. 5.

    The National Archives. UK Climate Change Act 2008. Available at (accessed January 2017).

  6. 6.

    Sustainable Development Unit. Carbon Hotspots. Available at (accessed January 2017).

  7. 7.

    , Evidence summary: can plastics used in dentistry act as an environmental pollutant? Can we avoid the use of plastics in dental practice? Br Dent J 2012; 212: 89–91.

  8. 8.

    . Investigation: Greening up the bottom line. Br Dent J 2014; 217: 10–11.

  9. 9.

    , . Eco-friendly Dentistry: The environmentally-responsible dental practice. University of Waterloo, 2007. Available at (accessed January 2017).

  10. 10.

    . Eco-friendly dentistry. Available at (accessed January 2017).

  11. 11.

    United Nations. Report of the World Commission on Environment and Development – General Assembly Resolution 42/187. 11 December 1987. Available at (accessed January 2017).

  12. 12.

    Sustainable Development Unit. Sustainable Development Strategy for the Health and Social Care System 2014–2020. Available at (accessed January 2017).

  13. 13.

    Sustainable Development Unit. Areas of Focus. Available at (accessed January 2017).

  14. 14.

    Sustainable Development Unit. Carbon Hotspots. Available at (accessed January 2017).

  15. 15.

    , , , . Phil. Trans. Plastics, the environment and human health: current consensus and future trends. Philos Trans R Soc Lond B Biol Sci 2009; 364: 2153–2166.

  16. 16.

    , , , , , . Parent bisphenol A accumulation in the human maternalfetalplacental unit. Environ Health Perspect 2002; 110: A703A707.

  17. 17.

    US Environment Protection Agency. Environmental assessment: Dioxin. Available at (accessed January 2017).

  18. 18.

    . Metals in municipal landfill leachate and their health effects. Am J Public Health 1977; 67: 429–432.

  19. 19.

    , . Bracket recyclingwho does what? Br J Orthod 1997; 24: 172–174.

  20. 20.

    , , , and Patient and parent opinion of the use of recycled orthodontic brackets: an international comparison. J Orthod 1997; 24: 329–332.

  21. 21.

    , . Going... Going... Going... Gone Green. Making Your Dental Practice Environmentally Friendly. J Mass Dent Soc 2010;59(2):26–32. Available at (accessed June 2017)

  22. 22.

    , , , , . Healthcare without harm. Guide to Choosing Safer Products and Chemicals: Implementing Chemicals Policy in Health Care. Healthcare without harm. Available at . (accessed January 2017).

  23. 23.

    , , editors. Oral Radiology: Principles and interpretation. St. Louis, Missouri: Mosby, Elsevier Inc., 2009.

  24. 24.

    . British Orthodontic Society revises guidelines for clinical radiography. Am J Orthod Dentofac Orthop 2008; 134: 597–598.

  25. 25.

    US Environment Protection Agency. Environmentally Preferable Purchasing. Available at (accessed January 2017).

  26. 26.

    Green Guide for Health Care. Available at (accessed January 2017).

  27. 27.

    , . Air pollution and its control in the dental operatory. In Christan A G, Harris N O The Dental Clinics of North America: Environmental protection in the dental operatory. pp. 453–475. Philadelphia, London, Toronto: W B. Saunders company, 1978.

  28. 28.

    The Ecology Global Network. Paper Chase. Available at (accessed January 2017).

  29. 29.

    Forest Stewardship Council. About FSC. Available at (accessed January 2017).

  30. 30.

    Programme for the Endorsement of Forest Certification. About us. Available at (accessed January 2017).

  31. 31.

    Eurostat. Waste Electrical and Electronic Equipment (WEEE). Available at (accessed January 2017).

  32. 32.

    US Environmental Protection Agency. Sustainable Marketplace: Greener Products and Services. Available at (accessed January 2017).

  33. 33.

    US Environmental Protection Agency. Reduce, reuse, recycle. Available at (accessed January 2017).

  34. 34.

    Healthcare without harm. How to Buy Better Computers: Going Beyond EPEAT. Available at (accessed January 2017).

  35. 35.

    Public Health England. Sustainable Development Unit. Sustainable, Resilient, Healthy People & Places. Module: Carbon hotspots. Available at (accessed January 2017).

  36. 36.

    Sustainable Development Unit. Energy and carbon management. Available at (accessed January 2017).

  37. 37.

    Europa. Resource efficiency in the building sector. Available at (accessed January 2017).

  38. 38.

    UKCIP. UKCP09: The climate of the United Kingdom and recent trends. Available at (accessed January 2017).

  39. 39.

    HM Government. Carbon Plan. Available at (accessed January 2017).

  40. 40.

    NHS Sustainable Development Unit. Designing the built environment. Available at (accessed January 2017).

  41. 41.

    Energy & Environment Research Unit. Energy: A beginner's Guide. Available at (accessed January 2017).

  42. 42.

    USAID ECO III Project. Energy Efficiency in Hospitals: Best Practice Guide. 2009. Available at (accessed January 2017).

  43. 43.

    Public Health England. Sustainable Development Unit. Sustainable, Resilient, Healthy People & PlacesModule: An Integrated Approach to Metrics. Available at (accessed January 2017).

  44. 44.

    Wikipedia. Sustainable Architecture. Available at (accessed January 2017).

  45. 45.

    Energy.gov. US Department of Energy's Energy Saver. Available at (accessed January 2017).

  46. 46.

    Energy star. Light bulbs. Available at (accessed January 2017).

  47. 47.

    Wikipedia. Green building. Available at (accessed January 2017).

  48. 48.

    . Eco-friendly Dentistry: Not a Matter of Choice. J Canadian Dent Assoc 2007; 73: Available at (accessed January 2017).

  49. 49.

    US Environment Protection Agency. EPA's Green Power Partnership: What is Green Power? Available at (accessed January 2017).

  50. 50.

    NHS Sustainable Development Unit. Case studies from the NHS Carbon Reduction Strategy. Available at (accessed January 2017).

  51. 51.

    Wikipedia. Zero-energy building. Available at: (accessed January 2017).

  52. 52.

    , , et al. What's in a bin: A case study of dental clinical waste composition and potential greenhouse gas emission savings. Br Dent J 2016; 220: 61–66.

  53. 53.

    , , . Teleorthodontics. Am J Orthod Dentofac Orthop 2017; 151: 219–221.

  54. 54.

    European Commission. Scientific Committee on Emerging and Newly Identified Health Risks (SCENIHR). The safety of dental amalgam and alternative dental restoration materials for patients and users Preliminary Report. 2007. Available at (accessed April 2017).

  55. 55.

    BDA. Dental Amalgam Fact File.British Dental Association. 2008. Available at (accessed April 2017).

  56. 56.

    BDA. Use of dental amalgam in the UK: what do I need to know? Available at (accessed March 2017).

  57. 57.

    Healthcare without harm. Non-Incineration Medical Waste Treatment Technologies. Available at (accessed January 2017).

  58. 58.

    , . Current status of nitrous oxide as a behavior management practice routine in pediatric dentistry. J Dent Child 2011; 78: 24–30.

  59. 59.

    . Why anaesthetists no longer use nitrous oxide. Anaesth Intensive Care 2007; 35: 808–809.

  60. 60.

    Sustainable Development Unit. Carbon Hotspots: Anaesthetic gases. Available at (accessed January 2017).

  61. 61.

    , , , , . A comparative study of sevoflurane sedation with nitrous oxide sedation for dental surgery. Int J OralMaxillofac Surg 2002; 31: 506–510.

  62. 62.

    Public Health England. Sustainable Development Unit. Sustainable, Resilient, Healthy People & PlacesModule: Commissioning and Procurement. Available at (accessed January 2017).

  63. 63.

    3M. 3M Sustainability. Available at (accessed January 2017).

  64. 64.

    Public Health England. Sustainable Development Unit. Sustainable, Resilient, Healthy People & Places–Module: Sustainable clinical and care models. Available at (accessed January 2017).

  65. 65.

    Public Health England. Sustainable Development Unit. Sustainable, Resilient, Healthy People & PlacesModule: Healthy, Sustainable and Resilient Communities. Available at (accessed January 2017).

  66. 66.

    Public Health England. Sustainable Development Unit. Sustainable, Resilient, Healthy People & Places–Module: Metrics. Available at (accessed January 2017).

  67. 67.

    . . . Archibald Taking a bite out of Scotland's dental carbon emissions in the transition to a low carbon future. Public Health 2012; 126: 770–777.

  68. 68.

    SmartPractice. Earth-Friendly Green Products. Available at (accessed January 2017).

  69. 69.

    , , , , . Exploring attitudes and knowledge of climate change and sustainability in a dental practice: A feasibility study into resource management. Br Dent J 2016; 220: 187–191.

  70. 70.

    Wikipedia. Bioplastic. Available at (accessed January 2017).

  71. 71.

    Public Health England. Sustainable Development Unit. Sustainable, Resilient, Healthy People & Places–Module: Leadership, Engagement and Development. Available at (accessed January 2017).

  72. 72.

    Centre for Building Performance and Diagnostics, Carnegie Mellon. Linking Energy to Health and Productivity in the Built Environment. Available at (accessed January 2017).

  73. 73.

    United Nations Environment Programme. Buildings and Climate Change – Summary for Decision-Makers. Available at (accessed January 2017).

  74. 74.

    , . Interventions that change clinician behaviour: mapping the literature. King's Fund, London, 2006.

  75. 75.

    , . Promoting professional behaviour change in healthcare: what interventions work, and why? A theory-led overview of systematic reviews. BMJ Open 2015; 5: e008592.

  76. 76.

    NHS Sustainable Development Unit. Saving Carbon Improving Health – NHS Carbon reduction strategy for England. 2009. Available at (accessed January 2017).

  77. 77.

    Sustainable Development Unit. Ipsos MORI research – the public's view. Available at (accessed January 2017).

  78. 78.

    . Orthodontic Office Design – Attracting patients to your practice. J Clin Orthod 2010; 64: 47–53.

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Author information

Affiliations

  1. Melaka Manipal Medical College, Orthodontics, Jalan Batu Hampar, Bukit Baru, Melaka, Melaka 75150, Malaysia

    • P. Mulimani

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Correspondence to P. Mulimani.

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DOI

https://doi.org/10.1038/sj.bdj.2017.546

Refereed Paper

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